Patient Education

Cancer Of The Vulva And Vagina

Although cancer of the vulva or vagina is very rare, it can still sometimes happen. The good news is that the cure rate is about 90%. However, it is still good to know the risk factors and warning signs that can point to this kind of cancer. This page will cover the basics about vulvar and vaginal cancer. 

WHAT IS THE DIFFERENCE BETWEEN CANCER AND PRECANCER?

It is normal for cells to grow, replenish, and divide themselves. Sometimes, though, cells can start to develop abnormally and grow out of control. These cells can either be benign, precancerous, or malignant (cancer). Oftentimes, precancerous cells have the potential to turn into cancer if they are not treated. Malignant cells invade and destroy neighboring tissues that are healthy and normal, or spread to other parts of the body. Malignant cells can cause so much damage so quickly, it is important to find cancer early, so it can be treated and removed. Doing a vulvar self-exam will help you notice any changes that could be indicative of problems.

WHAT ARE THE TYPES OF VULVAR AND VAGINAL CANCER?

Most cancers of the vulvar and vaginal area are skin cancers. They are called VIN (vulvar intraepithelial neoplasia) and VAIN (vaginal intraepithelial neoplasia) in precancerous stages. In later stages though, it can metastasize and invade the rest of the body. Other types of cancer that evolve on the vulva and vagina include: 

  • Melanoma: This is an advanced type of skin cancer, which starts with a mole like growth that gets bigger and changes in form or color over time. It may become irregularly shaped, and any parts affected on the genitals need to be removed. 
  • Adenocarcinoma: This cancer may look similar to eczema (red, scaly skin) on the vulva, and commonly results from Paget disease. 
  • Clear cell adenocarcinoma: A vaginal type of cancer that usually occurs in women whose mothers took diethylstilbestrol (DES) while pregnant. It is a synthetic form of estrogen. 

WHO IS AT RISK FOR VULVAR OR VAGINAL CANCER?

Although women of all ages can develop vulvar or vaginal cancer, it usually occurs in women around 50 years old, and advanced, invasive cancers are more common in women over 60. VIN, VAIN, and some other types of cancer are linked to the STD human papillomavirus (HPV), which causes over 90% of cervical cancer cases and 10% of vulvar/vaginal cancers. 

Vaginal Cancer: You may be at risk if

  • You were born between 1938 and 1971
  • Your mother took DES when she was pregnant with you
  • You have HPV

Vulvar Cancer: You may be at risk if

  • You are a white woman older than 60
  • You smoke
  • You have diabetes
  • You take steroids/other immune system weakening drugs.

WHAT ARE THE SYMPTOMS OF VULVAR/VAGINAL CANCER?

Luckily, these types of cancer oftentimes have early warning signs as to their development. There are usually noticeable changes in the affected areas:

Vulva: common symptoms of vulvar cancer include

  • Itching
  • Burning, pain, or other discomfort in the area
  • A sore on the vulva (raised or flat and there may be fluid or blood seeping)
  • Changes in the skin color (white, red, brown, or black)
  • A lump in the groin if the cancer has spread

Vagina: common symptoms of vagina cancer include

  • Bleeding after sexual intercourse
  • Watery discharge
  • A lump in the vagina
  • Painful sex

HOW CAN A DOCTOR DIAGNOSE THE CANCER?

There are several different ways a doctor can diagnose any symptoms you may have of vulvar/vaginal cancer. He or she will give you a regular exam. They may also perform a colposcopy to see the cells more clearly. Your doctor may also obtain a small sample of the abnormal tissue for lab testing. This is called a biopsy, and it can tell your doctor if it is precancer or more invasive cancer. You may also undergo a pap test or a pelvic exam.

HOW IS VULVAR/VAGINAL CANCER TREATED?

For precancer, surgery is the most common treatment option. Both VIN and VAIN are able to be removed, usually with laser surgery. Sometimes medication is prescribed to treat VAIN.

Cancer is slightly more intense to treat:

Vaginal: Most commonly, radiation therapy is used to treat vaginal cancer. This uses high energy rays to destroy the abnormal cells. Sometimes, surgery will also be used along with radiation. Chemotherapy is not commonly used on vaginal cancer.

Vulvar: This can require surgery, especially if it has spread to the lymph nodes in the groin.

 There are two types of surgery:

  • Wide local excision- cutting away the cancer and an area of normal appearing skin around it.
  • Vulvectomy- removal of the vulva including vaginal lips, and clitoris. 

The type of treatment you will undergo depends on the stage of cancer you have. Radiation therapy and chemotherapy may be used to control vulvar cancer.

WHAT SHOULD I EXPECT AFTER TREATMENT?

After treatment, you will have many follow up exams with your doctor, as well as needing to perform vulvar self- exams once a month. You may also discuss with your doctor how to restore the appearance of your genitals and sexual function loss you may have from removal of the clitoris.

HOW IS A VULVAR SELF-EXAM PERFORMED?

  1. Before you begin, make sure to wash your hands. Lie or sit in a position near a good light. Use a hand mirror to look at your vulva.
  2. Separate the outer labia, checking for swelling, redness, dark or light spots, bumps, or blisters.
  3. Separate the inner labia and look at the area between them as well as the vaginal entrance.
  4. Gently pull back the hood of the clitoris and examine that area.
  5. Inspect the areas around the urethra, anus, perineum, and the outside of the labia majora.

IN CONCLUSION

Although rare and usually serious when found, vulvar and vaginal cancers give early warning signs in most cases. Do monthly self-vulvar exams and make sure to report any changes to your doctor.